This section presents a summary of the main evaluation findings in relation to the elements in the RE-AIM framework.
Efficacy
Qualitative data suggested that children’s knowledge about healthy foods improved over the course of the programme, and they now had an improved capability to make small changes in their dietary choices, where supported. Stakeholders had noticed positive changes in knowledge/awareness amongst children, particularly related to certain Go-Golborne campaigns.
“I think it's had a really positive impact on the community; … children are more aware of their healthy eating choices, they are aware of what they should eat and shouldn't eat”. (Statutory partner, interviewed 2017)
“My children… they love all the projects and they came home and kept talking about it and my son was like, 'oh mummy I'm not having a doughnut, because it contains so much sugar!'”. (Parent, interviewed 2017)
Key messages around physical activity do not appear to have been absorbed so readily by the children. There was a greater sense of decisions being outside of the children’s control:
“… sometimes there’s good stuff going on but then if you are busy or like I have younger brothers then you can’t always go” (Child in Focus Group Discussion, 2018).
Parents reported that Go-Golborne had raised awareness of healthy eating and activity in a fun and enjoyable way, and had provided them with greater motivation to further support healthy choices for their children. The follow-up parent questionnaires, however, did not suggest an improvement in knowledge around key health-related recommendations.
Data from partners, parents, teachers and children appeared to suggest that attitudes amongst children and parents were shifting. Quantitative data gathered via the Child Nutrition Questionnaire (CNQ) (for years 5–6) identified a positive shift in attitudes (i.e. lower value scores on CNQ) towards eating fruit and vegetables across the four year period. The relationship between cohort and attitudes towards vegetables showed significant variance in intercepts across participants, var(u0j) = 2.65, X2 (9) = 130.18, p < .01. Results from the LMM suggest that attitudes in 2019 (M = 6.56, SD = 3.70) towards vegetables improved compared to at the start of Go Golborne in 2016 (M = 15.17, SD = 3.58), F(3,778.77) = 236.14, p < .01, (CI 95% = 4.89, 5.83).
The relationship between cohort and attitudes towards fruit also showed significant variance in intercepts across participants, var(u0j) = 3.54, X2 (9) = 184.12, p < .01. Results from the LMM suggest that attitudes in 2019 (M = 6.64, SD = 3.08) towards fruit improved compared to levels in 2016 (M = 17.53, SD = 3.08), F(3,721.16) = 1201.94, p < .01, (CI 95% = 9.95, 10.76).
The child questionnaire did not collect information on attitudes towards physical activity (due to the need to keep the length manageable), but rather focused on measuring changes in behaviour. Qualitative data highlighted that children associated physical activity with having fun and socialising with friends, rather than ‘being healthy’. However, having fun and socialising was also closely linked to the use of electronic devices. Other children, who appeared to enjoy more physical activity, pointed to the barriers to taking part and the lack of opportunities, both in school and out.
Partners reported that their collaboration with Go-Golborne improved their reach into schools or community settings, increased the creativity and relevance of the messages they delivered, and linked the campaign messages to their own frameworks. They reported making many useful new contacts, and benefiting from participating in Go-Golborne events through an increased awareness of local services. Responses to the stakeholder questionnaire highlighted, for example, new collaborations between different organisations and groups. Training provided by the programme enabled local staff members to feel more confident in delivering consistent messages about health and weight when working with families. Most partners felt the programme improved their ability to support healthy lifestyles in the community, e.g. through developing new skills or knowledge around supporting children and families.
The majority of parents responding to the 2019 questionnaire reported making positive changes to improve their children’s diet, increase the amount of physical activity, and decrease the amount of screen time their children engaged in. For example: 49% of parents responding to the survey reported making changes to reduce sugar (with cutting down on sweets and/or sugary snacks and having smaller portions of sugary foods/drinks being the most frequently cited examples), 56% to reduce salty/fatty snacks and 60% to increase fruit and vegetable consumption; 46% of parents reported making changes to be more active in travel to/from school; and 50% of parents reported making changes to reduce screen time. Partners and teachers reported seeing some of these changes beginning to happen, although they highlighted that there was still much progress to be made, that some families needed more support than others, and that there was a need to keep the momentum going.
Schools and local community venues/services were starting to make positive changes to support healthier diets and activity. Many different examples of changes were mentioned by organisations, including swapping the snacks and drinks provided for healthier alternatives, promoting healthier vending machines, organising and promoting walks and bike rides, creating and promoting new ways of encouraging active play, and running non-screen sessions during holiday times. Children, parents and partners referred to the changes that they had seen in local shops and venues, with, for example, some noticing a shift towards healthier options being available in shops and greater visibility of fruit and vegetables at street level. Teachers also detailed the continued and additional ways in which they were making healthier choices easier in school by, for example, having easy access to drinking water, offering active after school clubs, and proving fruit/vegetable snacks to key stage two pupils. These positive changes were being noticed by parents, with the majority of those responding to the 2019 survey agreeing that their child’s school actively supports healthy eating and active movement.
In the second stakeholder questionnaire, partners described a higher uptake of local activities – both those facilitated by their own organisation and those in other settings (e.g. local leisure centres), and there were increased referrals to child healthy weight services.
Across the six behaviour change themes, there was little quantitative evidence from the surveys of positive, sustained shifts in children’s behaviours. Most behaviours fluctuated across the four cohorts. The parent questionnaires also confirmed that there was much progress to be made in improving children’s behaviours to meet recommended levels. For example, in 2019, 65% of responding parents thought their child ate fewer than the recommended 5 a day; only 16% of parents said their child took part in vigorous activity on five days or more; and 27% of parents reported that their youngest child engages in two or more hours of screen time on a typical school day (60% on a typical weekend day). The behaviour change data is reported in full elsewhere (under review).
However, qualitative data suggested some positive shifts in behaviours. For example, partners reported that parents no longer brought sweet snacks or drinks to the activity sessions; and local shops and businesses reported fewer children buying sweets where partners had banned unhealthy snacks.
The data collected on children’s heights and weights indicated that the proportion of children in the ‘healthy weight’ category (according to BMI centiles) remained stable, with no statistically significant change over the four-year time period. The proportion of children in the ‘overweight’ and ‘very overweight’ categories also remained stable.